Abstract:
BACKGROUND:In Germany there are 5000 to 7000 new cases of atraumatic avascular necrosis of the femoral head in adults per year. It occurs mostly in middle age. An increased frequency of idiopathic cases can be observed. Chemotherapy, corticoids and kidney transplants are frequently associated with the disease. In most cases the disease occurs on both sides. Early diagnosis is of particular importance, since in early stages it is most likely to avoid late damage with joint destruction. Whereas previously the temporary operational joint preservation and subsequent joint replacement were often the only option of treatment, conservative and joint-preserving measures today play an increasing role. MATERIAL AND METHODS:After the AWMF guidelines for S3 guideline clinical questions were formulated. Over the period from 01/01/1970 to 31/05/2013 a literature search was conducted. Systematic reviews, metaanalyses, original papers and clinical trials of all designs were evaluated. There were a total of 3715 references, of which 422 for the assessment regarding SIGN were eligible and finally 180 were in accord with the defined inclusion and exclusion criteria. For the untreated course and the assessment of conservative measures, a total of 42 references was suitable. In formulating the recommendations the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system was used, which distinguishes A "shall", B "should" and 0 "can". RESULTS AND CONCLUSION:If left untreated, the aFKN within 2 years leads to a subchondral fracture and subsequent collapse. After the diagnosis of femoral head necrosis, the risk of a disease of the opposite side is high within the next 2 years, then unlikely. The sole conservative treatment brings no benefit for the treatment of atraumatic avascular necrosis in the adult. Although it improves function, less pain can be obtained, and surgical intervention can be delayed, the progression is not stopped. Conservative treatment must therefore always be part of the overall treatment. In ARCO stage I to II Iloprost may be considered as a pharmacological approach to reduce the pain and the bone marrow oedema. This also applies to alendronate. Since this is an off-label use, and thus a therapeutic trial, an appropriate patient education must take place. For the use of anticoagulants and statins, there is no recommendation. Also the hyperbaric oxygen therapy, shock waves and pulsating electromagnetic fields or electrical stimulation cannot be recommended.
journal_name
Z Orthop Unfalljournal_title
Zeitschrift fur Orthopadie und Unfallchirurgieauthors
Roth A,Beckmann J,Smolenski U,Fischer A,Jäger M,Tingart M,Rader C,Peters KM,Reppenhagen S,Nöth U,Heiss C,Maus Udoi
10.1055/s-0035-1545903subject
Has Abstractpub_date
2015-10-01 00:00:00pages
488-97issue
5eissn
1864-6697issn
1864-6743journal_volume
153pub_type
杂志文章abstract:BACKGROUND:A new emergency room (ER) has been established in our trauma centre including an integrated CT scanner. The former ER was located at a long distance from the CT. The aim of this study was to evaluate the influence of the integrated CT in the new ER on the time period from hospital admission to CT diagnostics...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/s-0032-1328403
更新日期:2013-04-01 00:00:00
abstract::The reasons for delayed fracture healing or non-union formation are multifactorial. Mechanical factors are well known to influence the process of fracture healing. However, there is a lack of knowledge about the biological conditions that have to be achieved for adequate bone healing. Treatment of non-unions is still ...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章,评审
doi:10.1055/s-0035-1546146
更新日期:2015-10-01 00:00:00
abstract:INTRODUCTION:Trauma or infectious diseases can cause destruction of the epiphyseal region of the knee with premature partial bridging of the physis and deviation of length and axis. There is only little information about tumorous lesions as pathogenetic factor for these deviations. We have been searching for an approac...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/s-2008-1038999
更新日期:2008-11-01 00:00:00
abstract::Ochronosis is a manifestation of the rare disease alkaptonuria. The most common presentations include pain in the lumbar spine region starting during the 3rd decade, spreading over the large joints. There exists no curative therapy for the disease at the moment. In the long-term the patients will be dependent on total...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/s-2008-1039225
更新日期:2009-05-01 00:00:00
abstract::The number of patients with meniscal injuries is increasing constantly, but the treatment algorithms are undergoing continuous change. The effects of meniscal surgery, as well as the indications for the procedure, are currently a matter of heated debate. Various German speaking associations addressing topics related t...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章,评审
doi:10.1055/s-0042-116683
更新日期:2017-04-01 00:00:00
abstract:BACKGROUND:The aim of this study was to assess the impact of Peyton's 4-step approach on musculoskeletal ultrasound skills in a peer-teaching environment as compared to traditional "see one, do one" training and to evaluate students' acceptance of the training strategy. MATERIAL AND METHODS:A total of 491 second year ...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章,随机对照试验
doi:10.1055/a-0715-2435
更新日期:2019-06-01 00:00:00
abstract::Tibial plateau fractures are complex articular injuries, especially if caused by high energy. For adequate treatment a decidedly clinical and radiographic diagnostic is required. The three-column-concept has proven as excellent surgical planningstool in this complex trauma. By (1) precisely considering the specific ch...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章,评审
doi:10.1055/s-0042-116779
更新日期:2017-06-01 00:00:00
abstract:BACKGROUND:The residency program for a specialist in orthopedics and trauma surgery is facing fundamental changes based on an initiative originating from the working group "medical training" of the German Medical Association (GMA). A survey indicated that 50 % of all trainees are dissatisfied with their current situati...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/s-0033-1345672
更新日期:2013-04-01 00:00:00
abstract:INTRODUCTION:The mechanical properties of acrylic bone cements are an important factor in determining an efficient load transmission between prosthesis and bone to guarantee the long-term stability in cemented hip arthroplasty. MATERIAL AND METHODS:Palacos and Refobacin Palacos specimens from 21 aseptically loosened f...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/s-2007-989324
更新日期:2008-01-01 00:00:00
abstract:BACKGROUND:The use of the tourniquet in total knee arthroplasty is still a subject of controversial discussion. Previous studies mainly focus on parameters like blood loss and operation time. The aim of this systematic review is to evaluate the postoperative outcome involving parameters such as pain intensity, analgesi...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/a-0983-3808
更新日期:2020-12-01 00:00:00
abstract:PURPOSE:The purpose of this study was to evaluate peri- and postoperative complications and the clinical/radiological results after hip resurfacing with the ASR prosthesis in patients with osteoarthritis. METHOD:A prospective cohort study was performed including all patients who received a hip resurfacing (ASR prosthe...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/s-2008-1038397
更新日期:2008-03-01 00:00:00
abstract:AIM:Problems with the patellofemoral joint are still one of the most common difficulties after total knee arthroplasty. One of the main reasons for these problems seems to be the rotatory malposition of the femoral component. We examined the rotation of the femoral component and the symmetry of the flexion gap of knee ...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/s-0029-1240587
更新日期:2011-12-01 00:00:00
abstract:BACKGROUND:The Morel-Lavallée lesion is one of the concomitant soft tissue lesions of pelvic fractures. Its role in spine fractures and its treatment in combination with osteosynthesis of pelvic or spine fractures have not yet been determined. The aim of this study was to analyse the best diagnostic and treatment optio...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章,评审
doi:10.1055/a-0596-8018
更新日期:2018-10-01 00:00:00
abstract:AIM:The aim of this study was to make a mid-term evaluation of an unconstrained pyrocarbon prosthesis (Ascension®) in the treatment of idiopathic degenerative arthritis of the proximal interphalangeal joint of the hand. METHOD:13 implants (10 patients) were clinically and radiologically studied after a follow-up perio...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 临床试验,杂志文章
doi:10.1055/s-0031-1298389
更新日期:2012-06-01 00:00:00
abstract::Soft tissue injury in total hip replacements has recently developed into a main topic of orthopaedic surgery. The M. glutaeus medius is at risk to be injured in Watson-Jones' approach to the hip. A special technique in positioning of the leg offers the possibility to save the integrity of the muscles. While profiling ...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/s-0034-1368207
更新日期:2014-04-01 00:00:00
abstract::The ideal treatment for massive rotator cuff tears is influenced by the morphology and chronicity of the tear, tissue quality, the degree of concomitant osteoarthritis, and patient-specific factors. Traditionally, massive rotator cuff tears have wrongly been equated with irreparable tears. A variety of improvements in...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章,评审
doi:10.1055/s-0035-1558056
更新日期:2016-02-01 00:00:00
abstract:BACKGROUND:The concept of combined anteversion for total hip arthroplasty (THA) proposes a relationship between the cup and stem components that theoretically maximises the postoperative range of motion and minimises the risk for impingement of the joint. Using computer-assisted navigation tools, an anteversion angle o...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/s-0029-1240969
更新日期:2010-03-01 00:00:00
abstract::Fractures of the scapula are rare and have an incidence of 1% of all fractures. Publications highlight glenoid rim fractures. Classification by Ideberg and Euler and Rüdi are accepted. Euler and Rüdi describe three extra-articular and two intra-articular fracture patterns. The indications for surgery are displaced gle...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/a-0576-2036
更新日期:2018-08-01 00:00:00
abstract:AIM:In this prospective study we have analysed the clinical outcome of complex distal radius fractures that were reduced by a dorsal approach and fixed with 2 dorsal locking plates. METHODS:In the period from January 2006 to June 2008 60 patients with a distal intra-articular instable radius fracture, who were treated...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/s-0029-1186156
更新日期:2010-01-01 00:00:00
abstract:BACKGROUND:Hallux valgus is one of the most prevalent foot deformities, and surgical treatment of Hallux valgus is one of the most common procedures in foot and ankle surgery. Diagnostic and treatment standards show large variation despite medical guidelines and national foot and ankle societies. The aim of this nation...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/s-0043-120352
更新日期:2018-04-01 00:00:00
abstract::Anterior dynamic scoliosis correction is an innovative non-fusion option in the treatment of patients with severe adolescent scoliosis. Growth modulation and sometimes intraoperative curve correction is achieved by convex insertion of segmental screws and a flexible polyethylene cord. The present review analyses and d...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/a-0983-1265
更新日期:2020-12-01 00:00:00
abstract:AIM:Whole body spiral CT scans have become a routine method in the radiological imaging of severely injured patients in emergency rooms of an increasing number of hospitals. The routine use of CT scans is, however, still discussed controversially, especially with regard to its use in children. This is mainly due to the...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/s-2007-989438
更新日期:2008-01-01 00:00:00
abstract::Objective Development of a preparation technique for hamstring tendons to ensure a maximum of intraoperative flexibility during individualised cruciate ligament surgery. Indications Primary ACL- and PCL-reconstruction as well as cases of later revision. Method Three- or five-stranded grafts can be obtained with the us...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/s-0043-119899
更新日期:2017-12-01 00:00:00
abstract::Surgical principles for treatment of full-thickness cartilage defects of the knee include bone marrow stimulation techniques (i.e. arthroscopic microfracturing) and transplantation techniques (i.e. autologous chondrocyte implantation and osteochondral transplantation). On the basis of increasing scientific evidence, i...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 共识发展会议,杂志文章,评审
doi:10.1055/a-0591-6457
更新日期:2018-10-01 00:00:00
abstract::Bone sarcomas are extremely rare representing approximately 0.2% among all cancer types. Due to the rarity of these tumors both the patients and the physicians can overlook or misinterpret the first often unspecific symptoms of these tumors (pain, limping and swelling). Therefore, radiographic examination (X-ray and/o...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章,评审
doi:10.1055/s-0043-117905
更新日期:2018-02-01 00:00:00
abstract::Injuries to the lateral ankle ligaments are the most common sports injuries. Determination of their severity and exclusion of relevant accompanying injuries requires a subtle clinical and a focussed radiological assessment. Treatment is non-operative and functional in the majority of cases. Consequent application of o...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章,评审
doi:10.1055/s-0031-1280258
更新日期:2011-10-01 00:00:00
abstract::The present refresher article highlights the current role of pedicled flaps in the reconstruction of complex wounds at the lower extremity. Due to the increasing standardization and ongoing improvements in microsurgery and in view of the fact that local tissue limitation and elevated rates of wound healing disorders r...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/s-0043-124091
更新日期:2019-02-01 00:00:00
abstract:BACKGROUND:Osteochondral lesions (OCL) of the talus show a distinct distribution pattern. Vascular, metabolic, idiopathic, and biomechanical factors have been proposed as influencing factors. However, the association of hindfoot alignment and the location of talar OCL is not known. MATERIALS AND METHODS:In 22 patients...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/s-0034-1368604
更新日期:2014-08-01 00:00:00
abstract:BACKGROUND:The design and the surgical technique of the Silent Micro Hip™ are different compared to other hip stems due to a conical shape for fixation within the metaphyseal femur. The purpose of the present study was to evaluate hip joint biomechanics of the Silent Micro Hip™ in comparison to other implants. Implant-...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/s-0033-1350862
更新日期:2013-10-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to perform a cross-cultural adaption of the KOOS into Chinese and to evaluate its psychometric properties in patients with anterior cruciate ligament reconstruction (ACL reconstruction) in mainland China. DESIGN:A cross-sectional study. SETTING:Patients completed the Chinese versio...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/a-0621-9504
更新日期:2019-02-01 00:00:00